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Amnesty International may be best known to American audiences for
bringing to light horror stories abroad such as the disappearance of
political activists in Argentina or the abysmal conditions inside South
African prisons under apartheid. But in a new report on pregnancy and
childbirth care in the U.S., Amnesty details the maternal-health care crisis
in this country as part of a systemic violation of women's rights.

The report, titled "Deadly Delivery," notes that the likelihood of a
woman's dying in childbirth in the U.S. is ﬁve times as great as in Greece,
four times as great as in Germany and three times as great as in Spain.
Every day in the U.S., more than two women die of pregnancy-related causes,
with the maternal mortality ratio doubling from 6.6 deaths per 100,000
births in 1987 to 13.3 deaths per 100,000 births in 2006. (And as shocking
as these figures are, Amnesty notes that the actual number of maternal
deaths in the U.S. may be a lot higher, since there are no federal
requirements to report these outcomes and since data collection at the state
and local levels needs to be improved.) "In the U.S., we spend more than any
country on health care, yet American women are at greater risk of dying from
pregnancy-related causes than in 40 other countries," says Nan Strauss, the
report's co-author, who spent two years investigating the issue of maternal
mortality worldwide. "We thought that was scandalous." (See the most common hospital mishaps.)

According to Amnesty, which gathered data from many sources, including the
Centers for Disease Control and Prevention, approximately half of the pregnancy-related deaths in the U.S. are
preventable, the result of systemic failures, including barriers to accessing
care; inadequate, neglectful or discriminatory care; and overuse of risky
interventions like inducing labor and delivering via cesarean section.
"Women are not dying from complex, mysterious causes that we don't know how
to treat," says Strauss. "Women are dying because it's a fragmented system,
and they are not getting the comprehensive services that they need."

The report notes that black women in the U.S. are nearly four times as
likely as white women to die from pregnancy-related causes, although they
are no more likely to experience certain complications like hemorrhage. (See the top 10 medical breakthroughs of 2009.)

The Amnesty report comes on the heels of an investigation in California
that found that maternal deaths have tripled there in recent years, as well as a
maternal-mortality alert issued in January by the Joint Commission, a group
that accredits hospitals and other medical organizations, which noted that
common preventable errors included failure to control blood pressure in
hypertensive women and failure to pay attention to vital signs after
C-sections. And just this week, a panel of medical experts at a conference
held by the National Institutes of Health (NIH) recommended that physicians'
organizations revisit policies that prevent women from having vaginal births
after having had a cesarean. Such policies, designed in part to protect
against litigation, have contributed to the rise of the U.S. cesarean rate to
nearly 32% in 2007, the most recent year for which data are available.

The Amnesty report spotlights numerous barriers women face in accessing
care, even among those who are insured or qualify for Medicaid. Poverty is a
major factor, but all women are put at risk by overuse of obstetrical
intervention and barriers to access to more woman-centered, physiologic care
provided by family-practice physicians and midwives.

Amnesty is calling on Obama to create an Office of Maternal Health within
the Department of Health and Human Services to improve outcomes and reduce
disparities, among other recommendations. The report also calls on the
government to address the shortage of maternal-care providers.

"Access is only one factor," cautions Maureen Corry, executive director
of Childbirth Connection, a research and advocacy organization that recently
convened more than 100 stakeholders, including members of the American College of
Obstetricians & Gynecologists and the NIH, in a large symposium on
transforming maternity care. "We need to make sure that we reduce the
overuse of interventions that are not always necessary, like C-sections, and
increase access to the care that we know is good for mothers and babies,
like labor support."